Neurological Disorders

Psychological Disorders

10 million people suffer from depression

Mood Disorders

Mood Disorders•Unipolar Disorder (2 wks to 9 mos)

•Major Depressive Disorder, Single Episode (MDDSE)•rare

•Major Depressive Disorder, Recurrent (MDDR)•family history is common

•Dysthymic Disorder (DD)•milder symptoms•chronic occurrence (2-30yrs)

•Double Depression•combination or MDDR and DD

•Bipolar Disorder (2 wks to 9 mos)•Bipolar I Disorder•Bipolar II Disorder (hypomania)

•Dysphoric Mania•manic episodes with simultaneous depression

•Cyclothymic Disorder (mild bipolar)

Major Depressive

Episode Characteristics

•Onset is in early to mid 20’s•but not age specific

•Onset age has been dropping

•16% of population experienceMDD in their lifetime

•2:1 women to men ratio

•41% occurs just before or justafter menstruation

Depression: Etiology

Biological Influencegenetic predispostionneurochemical imbalancestress hormones

Psychological/Behavioral Influencelearned helplessness/hopelessnessdepressive attributional styledisturbed sleep habits

Social Influencestressful events serve as triggers

Mood Disorders among Twins

Depression and Neurochemistry

Depression and Stress Hormones

Depression and Sleep

Phase advanced body temperature rhythms

Enter REM sleep earlier in the night

Spend little time in SWS

Depression: Treatment

MedicalChemicalElectroconvulsive Shock Therapy

PsychotherapyCognitive Behavioral TherapyInterpersonal Therapy

Chemical Treatment•Tricyclic Antidepressants

•imipramine (Tofranil)•prevents monoamine reuptake•64% respond well•many side effects

•Monoamine Oxidase Inhibitors•phenelzine (Nardil)•blocks MAO enzyme

•which breaks down monoamines•<64% respond well•several lethal side effects

•Selective Serotonin Reuptake Inhibitors (SSRIs)•fluoxetine (Prozac)•blocks reuptake of serotonin•minor side effects

Electroconvulsive Shock Therapy

•for patients where drugs are ineffective or that can’t wait for drugs to take effect•electric shock to the cortex for less than 1 second•creates seizure and mild convulsions•takes about 6-10 sessions every other day•some short term memory loss•50-70% beneficial•60% relapse rate

(ECT)

Cognitive Behavioral Therapy

•make patient examine thought process and recognize errors•arbitrary interference•overgeneralization

•try to correct cognitive errors•concentrate on less depressive thoughts - be more realistic

•target negative cognitive schemes•use journals to identify faulty thinking•do hypothesis testing•put fun back into the patients life•increase exercise•takes about 10-20 sessions

Interpersonal Therapy

•resolve problems in existing relationships•identify life stressors•work on interpersonal disputes

•role disputes•loss of a relationship•acquiring new relationships•identifying and correcting deficits in social skills

•takes about 15-20 sessions

Depressions Vicious Cycle

Must control brain chemistry

e.g., Prozac

Must reshape the negative thought processes

e.g., CBT